Why do men with urethritis in Cameroon prefer to seek care in the informal health sector?

OBJECTIVE: To study the impact of cost of treatment for sexually transmitted diseases (STDs) on the preference of men with urethritis to seek care in the informal sector. SUBJECTS AND METHODS: A random sample of young men from the general population of Yaoundé and Douala, Cameroon, and of employees of a Yaoundé factory underwent a structured interview on the occurrence of STD-related complaints and health seeking behaviour. Men who consulted in the formal sector were compared with men consulting in the informal sector, with regards to cost of medication and level of education. RESULTS: Sixteen percent of men in the general population and 20% of factory employees reported a history of urethritis in the 12 months preceding the interview. Of the men in the general population 53% had sought care in the formal sector; among the factory employees this proportion was 56%. Men who did not consult in the formal sector spent significantly less on drugs than men who did consult in the formal sector: median cost $14.4 versus $24.0 (p = 0.02) for drugs purchased in pharmacies; median cost $8 versus $32 for drugs purchased in small stores or from acquaintances. Preference for formal health services was associated with higher educational attainment. CONCLUSION: In large towns in Cameroon the utilisation of formal health services for STD related complaints is low and the high cost of treatment in the formal sector may play an important role in the choice of care option.

The urethral syndrome: a controlled evaluation.

It has long been considered that psychological factors play an important rôle in women with urinary tract symptoms. Where no significant infection can be demonstrated, psychological factors have been claimed as paramount to the extent that the 'irritable urethral syndrome' has been postulated as a parallel to the irritable bowel. This paper reports on a controlled study of psychological and menstrual problems in women presenting in family practice with urinary symptoms. Women were assessed by structured interview. Two groups of women took part: (A) 54 women with urinary symptoms, 15 of whom later proved to have significant bacterial infection on culture. (B) 21 women attending for contraceptive advice also agreed to participate in a comparison group. Women presenting with urinary tract symptoms had higher mean scores on psychological and menstrual measures than comparison women, regardless of the presence of demonstrable infection. Thus, psychological and menstrual symptoms appear to determine whether a woman who experiences urinary tract symptoms attends her doctor, regardless of whether significant infection is present. No evidence was found, for the existence of an irritable urethral syndrome, in which psychological factors are postulated as the predominant cause.

Urethral syndrome: a study in psychosomatic urology.

The authors studied a sampling of 50 female patients diagnosed with urethral syndrome (urinary symptoms and pain without infection or organic lesion) on purpose to explore some psychological aspects. The evaluation procedure began with a complete urodynamic examination followed by a clinical interview. After this all patients were given three questionnaires: Symptom Questionnaire, Illness Behaviour Questionnaire and a Biographic Questionnaire prepared specifically for this study. Statistical analysis of the data showed higher levels of hostility, irritability, anxiety, dysphoria and depression in the group of patients than in the control group. There was also a marked tendency to suffer from psychophysiological symptoms.

Patterns of psychiatric morbidity in a genito-urinary clinic. A validation of the Hospital Anxiety Depression scale (HAD).

The prevalence of psychiatric disorder (by DSM-III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.

Psychosexual trauma of an abnormal cervical smear.

The psychosexual sequelae of diagnosis and treatment of pre-invasive cervical atypia were assessed in three groups of women. The first group included 30 women referred to a colposcopy clinic with an abnormal cervical smear indicating cervical intraepithelial neoplasia (CIN), the second comprised 50 women who were traced as sexual partners of men with penile human papillomavirus (HPV) infection; 26 of them had histologically proven cervical atypia and 24 had no such evidence. The third group included 25 women traced as partners of men with non-specific urethritis and who did not have cervical disease. Before and after questionnaires assessed six aspects of sexual behaviour and responses before diagnosis and 6 months after treatment in women with cervical atypia. These were compared with answers given by women investigated and treated, if necessary, as partners of men with sexually transmitted disease (control group). There were statistically significant adverse psychosexual sequelae associated with diagnosis and treatment of pre-invasive cervical epithelial disease.